They earn enough to potentially pay a modest insurance premium but may not qualify for free government health cover. At the same time, private health insurance can be too expensive or inadequate for their needs.
This includes informal workers, gig workers and the self-employed.
For many of these households, healthcare costs still come directly out of their income and savings. The average out-of-pocket expenditure per hospitalisation is ₹34,064.
The gap between public and private healthcare costs is also stark.
The average hospitalisation cost at a government/public facility is ₹6,631, compared with ₹50,508 at a private hospital. That’s more than a seven-fold difference.
With medical inflation running at around 10–13% a year, even a single hospitalisation can become a significant financial shock for households.
The Committee has also flagged practices such as linking treatment charges to room rent. This can mean that the same procedure costs more simply because a patient chooses a more expensive room.
What does Parliament recommend for the “missing middle”?
The Committee has recommended a standardised insurance product priced at around ₹4,000–₹6,000 per family per year, building on the Aarogya Sanjeevani model. The proposed product would have minimal waiting periods and include OPD coverage.
It has also recommended encouraging employers to contribute ₹100–₹200 a month towards insurance for gig and informal workers.
Other recommendations include standardised treatment protocols and an end to differential billing practices, including room-rent-linked pricing.
The Committee has also suggested that OPD and maternity coverage become standard features rather than expensive add-ons.
The insurance system is already paying out, with insurers settling around ₹94,248 crore in claims last year.
The larger question is whether India can build an affordable insurance product for the 40 crore people who continue to fall through the gaps in the existing health insurance system.
